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Treatment in Clifton, NJ

Urethral Fistula Repair After Phalloplasty or Metoidioplasty

Restore Comfort & Urinary Function

Introduction To Urethral Fistula Repair After Phalloplasty or Metoidioplasty

A urethrocutaneous fistula is an abnormal opening between the reconstructed urethra and the skin. After phalloplasty or metoidioplasty with urethral lengthening, urine may leak through this opening instead of traveling entirely through the tip of the reconstructed phallus. Some fistulas are small and close during healing, while persistent or complex fistulas require reconstructive surgery.

At East Coast Advanced Urology in Clifton, NJ, Dr. Karl Coutinho treats urethral fistulas after masculinizing gender-affirming surgery. The repair is planned around the location of the fistula, the presence of urethral narrowing, prior operations, available tissue, and the blood supply of the surrounding reconstruction.

Dr. Coutinho is also a member of the multidisciplinary surgical team at Gender Affirming Medical and Microsurgical Associates (GAMMA), where he works alongside gender-affirming plastic and reconstructive surgeons. In many gender-affirming procedures, Dr. Coutinho focuses on the urologic and urethral portions of reconstruction while the plastic surgery team performs the complementary reconstructive portions. This collaborative approach allows each part of a complex, often staged reconstruction to be managed by a surgeon with focused expertise.

Confident man with crossed arms wearing casual gray t-shirt against wooden wall background - Urethral fistula repair in Clifton, NJ

What Is Urethral Fistula Repair After Phalloplasty or Metoidioplasty?

Urethral fistula repair is reconstructive surgery used to close the abnormal pathway and restore urine flow through the intended urethral channel. Before repairing the opening, it is important to determine whether a urethral stricture is present because pressure behind a narrowing can contribute to persistent leakage or fistula recurrence.

A small, well-localized fistula may be closed primarily after removing the tract and bringing healthy tissue together. More complex defects may require additional tissue. Buccal mucosa from the inside of the mouth can be used to patch or augment the urethra, and local or regional vascularized tissue can be placed over the repair to separate suture lines and improve coverage. In heavily scarred or previously repaired areas, a staged plan may be safer.

Related Gender-Affirming Urologic Care

Fistulas often need to be considered together with the rest of the urinary reconstruction. Dr. Coutinho evaluates for associated problems that could make a fistula more likely to persist or recur.

A narrowing can increase pressure within the urethra and contribute to leakage through a fistula. If a stricture is present, simply closing the fistula without addressing the obstruction may not be adequate.

Who Are the Best Candidates for Urethral Fistula Repair?

Not every fistula needs immediate surgery. Early fistulas may close over time with urinary drainage and wound care. Surgery is more commonly considered when the fistula persists after healing, causes meaningful symptoms, recurs after prior repair, or occurs with a urethral stricture.

Patients who may be candidates for urethral fistula repair include those who:

  • Have persistent urine leakage from the skin after phalloplasty or metoidioplasty
  • Have a fistula that has not closed with an appropriate period of healing and urinary drainage
  • Have a recurrent fistula after previous repair
  • Have an associated urethral stricture that also requires treatment
  • Have adequately healed tissue for reconstruction or are willing to undergo a staged repair when needed

What Are the Benefits of Urethral Fistula Repair?

Repair goals depend on the fistula and the condition of the surrounding urethra. Potential benefits may include:

  • Stopping urine leakage through an abnormal opening
  • Restoring a more direct urinary stream through the reconstructed urethra
  • Treating an associated urethral stricture when present
  • Reducing skin irritation and recurrent inflammation from urine leakage
  • Using healthy tissue coverage to support a previously operated urethra
  • Helping prepare the urinary reconstruction for later stages of gender-affirming surgery
Urethral Lengthening After Phalloplasty-evaluation

How to Begin Your Urethral Fistula Repair Journey

The first step is to define both the fistula and the rest of the reconstructed urethra. Your evaluation may include:

  • Review of the original phalloplasty or metoidioplasty operative reports
  • Review of prior urethral lengthening and any previous fistula or stricture procedures
  • Physical examination of the fistula and surrounding tissue
  • Cystoscopy to inspect the urethral channel when appropriate
  • Retrograde urethrogram or other imaging to identify narrowing or additional leakage
  • Discussion of whether repair should be performed in one stage or as part of a staged reconstruction

What to Expect on the Day of Urethral Fistula Repair

Fistula repair is performed under anesthesia. Dr. Coutinho identifies the abnormal tract and evaluates the quality of the urethral edges and surrounding tissue. If a stricture is present, it must be incorporated into the reconstructive plan.

Depending on the defect, the fistula may be excised and closed primarily, or the urethra may be augmented using tissue such as buccal mucosa from the mouth. Additional local tissue or vascularized flap coverage may be placed over the urethral closure to help protect the repair. In complex recurrent cases, more than one stage may be necessary.

A urethral catheter is commonly used to keep urine away from the repair while it heals. Some patients also require a suprapubic tube for additional urinary diversion.

Urethral Lengthening After Phalloplasty-expect

Urethral Fistula Repair Recovery

Your Guide to Post-Urethral Fistula Repair Care

Recovery depends on the size and location of the fistula and whether the urethra required additional reconstruction. A catheter is usually kept in place while the repair heals, and a suprapubic tube may be used in selected patients.

Dr. Coutinho may use imaging or direct visualization of the urethra before removing urinary drainage. Follow-up continues after catheter removal because recurrent leakage or developing narrowing can occasionally appear later.

How Much Does Urethral Fistula Repair Cost in New Jersey?

The cost of urethral fistula repair in Clifton, NJ, and the greater New York metropolitan area depends on the complexity of the defect, whether a urethral stricture is repaired at the same time, whether graft or flap tissue is required, the surgical setting, and insurance coverage. After evaluation, our office can review the proposed urologic reconstruction and anticipated insurance responsibility.

Why Choose Dr. Coutinho?

Dr. Karl Coutinho is a fellowship-trained reconstructive urologist with advanced training in genitourinary trauma, urethral reconstruction, and prosthetic surgery. He is a founding member of the Society of Gender Surgeons and is part of the multidisciplinary Gender Affirming Medical and Microsurgical Associates (GAMMA) surgical team, where he works alongside gender-affirming plastic and reconstructive surgeons.

In many masculinizing genital procedures, Dr. Coutinho focuses on the urologic and urethral portions of reconstruction while the plastic surgery team performs complementary reconstructive portions. This collaborative model is particularly important because urethral reconstruction, soft-tissue coverage, flap blood supply, wound healing, and future prosthetic surgery all affect one another. Every patient’s anatomy, prior operations, and goals are different, so care is individualized and often staged.

Dr. Coutinho’s reconstructive practice includes both the initial urethral portions of gender-affirming surgery and the management of later complications. This is useful in fistula care because the visible opening is only one part of the problem; the reconstructed urethra, blood supply, prior scar, and any associated stricture need to be considered before repair.

His experience with fistula surgery also extends beyond gender-affirming reconstruction. He has given an academic presentation on the surgical management of rectourethral fistulae and authored a book chapter on complications of urologic surgery in previously irradiated tissue. These experiences reinforce an approach centered on tissue quality, vascularity, layered reconstruction, and individualized use of grafts or flaps when necessary.

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Urethral Fistula Repair After Phalloplasty or Metoidioplasty FAQ’S

For more information on Gender Affirming Care, please visit our partners at Gamma

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Patient Reviews

  • My surgery was life changing and the recovery period was better than I ever expected. I would highly recommend Dr Coutinho , he is the best.

    View Gallery Claude R.

  • I had an outstanding experience with Dr. Coutinho and their entire urology team. They truly go above and beyond.

    View Gallery Jenney S.

  • Dr Karl Coutinho is an excellent doctor in his field. He made me feel whole again after doing two procedures for me.

    View Gallery Keith A.

  • I’ve never met a doctor so empathetic

    I’ve never met a doctor so empathetic, professional and Knowledgeable Dr Coutinho performed a very difficult surgery on me. I had absolutely no pain.

    View Gallery
Patient Reviews

East Coast Advanced Urology

Schedule Your Consultation

If urine is leaking through an abnormal opening after phalloplasty or metoidioplasty, schedule a consultation with Dr. Karl Coutinho at East Coast Advanced Urology in Clifton, NJ. If possible, bring prior operative reports and information about any previous catheter, fistula, or stricture treatments. Dr. Coutinho welcomes patients from throughout New Jersey and the greater New York metropolitan area.

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